Non-Structural Cancellous Bone Graft and Headless Compression Screw Fixation for Treatment of Scaphoid Waist Nonunion

Abstract

Purpose Scaphoid fracture commonly occurs around the mid-third of the scaphoid, and non-union of this fracture has several treatment options. The authors performed autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist non-union. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. Methods Medical records and radiographs of 30 patients who underwent cancellous bone graft and headless compression screw fixation for non-union of scaphoid waist fracture were retrospectively reviewed. There were 28 men and 2 women, with a mean age of 32.8 years (range: 21–63). The mean time to surgery was 10 months (range: 3–25) and mean follow-up was 37.5 months (range: 15–52). The authors analyzed bony union, lateral intrascaphoid angle, scapholunate angle, radiolunate angle and scaphoid length on radiographs and evaluated the Modified Mayo wrist score (MMWS) as a functional outcome. Results Bony union was achieved in all cases. The lateral intrascaphoid angle improved from 40° to 32° (P < 0.001). The scapholunate angle also improved from 61° to 56° (P = 0.009). The radiolunate angle decreased from 8° to 4° (P = 0.048) and scaphoid length increased from 22 mm to 26 mm (P < 0.001) postoperatively. Wrist motion and MMWS improved significantly at last follow-up. However, there were no significant differences between scaphoid deformity correction angle and pre- to post-operative difference in MMWS. Conclusions Non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II non-union in the mid-third of the scaphoid. Level of evidence Level III.